Disseminated intravascular coagulation: clinical complexities of aberrant coagulation

When the critically ill patient's clinical course is complicated by disseminated intravascular coagulation (DIC), significant physiologic disequilibrium and life-threatening multisystem events ensue. DIC occurs when an underlying pathologic condition triggers overstimulation of the normal coagulation mechanism resulting in a perplexing clinical picture of disseminated coagulation and excessive fibrinolysis. This article presents a review of normal coagulation physiology and the alterations producing the physiology derangements in DIC. Diagnostic and clinical assessment parameters and therapeutic management goals for the critically ill DIC patient also are included. The critical care nurse's role in knowledgeable assessment, rapid intervention, and ongoing evaluation of the patient's therapeutic responses are essential to maximize positive outcomes for the DIC patient.